(400) COVID-19 and Planned Community Birth

Objective: To determine if there was a change in the proportion of planned community birth during the COVID-19 pandemic in Oregon.

Study Design: Retrospective cohort study of singleton births in Oregon from January 2019 to December 2020. Births were categorized into pre-COVID (January 2019 to February 2020) and post-COVID (March 2020 to December 2020). Primary outcome was planned place of delivery (in-hospital or community birth). We utilized descriptive statistics and chi-square test to compare pre-COVID vs. post-COVID populations. Interrupted time series analysis of intended community birth trends in relation to COVID-initiation (March 2020) was conducted using the Newey-West standard errors.

Results: 79,639 births met inclusion criteria, 96% (n= 76,208) in-hospital births and 4% (n=3,431) planned community births. The proportion of planned community births increased significantly from pre-COVID to post-COVID period (3.9% vs 4.8%; p< 0.001); whereas the proportion of in-hospital births significantly decreased (96.0% vs 95.2%; p< 0.001). Time series analysis of in-hospital births showed estimated in-hospital deliveries per total deliveries in January 2019 were 96.1% (95% CI: 95.7%-96.4%; p< 0.001) with a decrease in-hospital deliveries by 1.0% (95% CI: -2.07 to -0.05%; p=0.06) in March 2020. Conversely, estimated community deliveries per total deliveries in January 2019 were 3.94% (95% CI: 3.54%-4.33%; p< 0.001) with an increase in community deliveries by 1.0% (95% CI: -0.05 to 2.07%; p=0.06) in March 2020. Maternal and perinatal outcomes were reviewed as secondary outcomes. We found lower rates of hypertensive disease (3.2% vs 1.8%, p=0.009) and decreased rates of induction of labor (6.1% vs 4.2%, p=0.014) among planned community births post-COVID compared with pre-COVID. There were no differences in available neonatal outcomes.

Conclusion: There was a significant increase in the proportion of planned community birth in Oregon during the COVID-19 pandemic with the largest increase occurring in the first few months of the pandemic from April to June 2020. Available perinatal outcomes were unchanged.